Hector is a 20-year-old football player in his junior year at his state university. Hector developed lower back pain around the beginning of his football season 4 months ago, and the pain has slowly worsened over the course of the season. He remembers the pain starting after one particularly hard practice but he does not remember any particular tackle or injury occurring during that practice. There was no “pop” that precipitated the pain. At first Hector thought that his lower back muscles were “just sore” as they often were, but as the pain persisted and then significantly worsened in the last month, he became worried that something might really be wrong with his lower back.

Hector’s lower back pain spreads across his lower back around his L4, L5, and S1 region. The pain does not radiate into the legs. He denies any numbness or tingling in the legs. He denies any subjective weakness in the legs. The pain is constant but is worse when he plays football. The pain is also worse with prolonged standing or prolonged sitting. The pain is worse with rotation of his lumbar spine and he has very bad pain with transitions from sit to stand. Sometimes after a long practice or game the pain becomes so bad that he has a lot of trouble falling asleep at night and then the pain sometimes wakes him up when he does fall asleep.

Hector has not had any imaging studies. He has been to his football team’s trainers on multiple occasions and had many massages. Massages help temporarily. Hot packs and ice baths help the pain temporarily. He has been taking 800 mg of ibuprofen three times per day for the last month and he is not sure if that helps or not but he figured it would reduce the inflammation. He has taken some muscle relaxers that a friend of his gave him to try. The muscle relaxers did not help. When asked how he makes it through the game with all of his pain, Hector says that once he starts playing in a game, his adrenaline “takes over” and he doesn’t think about the pain. However, after the game he rates his pain in his lower back as 9/10 on VAS. At best, his pain in the last month is 4/10 when taking the 800 mg of ibuprofen and resting.

Hector is very concerned about being able to continue playing football. He has a full football scholarship to his university. He is not thinking of turning professional after college but he says that he needs to keep playing to keep his scholarship. Also, he loves playing football and wants to keep playing for that reason, too. After graduating college, Hector plans on going to graduate school to get his Ph.D. in chemistry. Hector did not want to go to a doctor at first but the lower back pain has been getting worse and affecting his ability to concentrate on his studies and also making it more and more difficult to play football at his top performance level.